360902129-3-3-2025-56-AS-EMAN-DEVS5J-20250318133426

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902129
Report Date: 03/03/2025
Date Signed: 03/03/2025 04:25:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2024 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240701105144

FACILITY NAME:	BRASWELL'S CHATEAU VILLA		FACILITY NUMBER:	360902129
ADMINISTRATOR:	MELANIE NIEZ		FACILITY TYPE:	740
ADDRESS:	620 E. HIGHLAND AVENUE		TELEPHONE:	(909) 793-0433
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92374
CAPACITY:	156	CENSUS: 102	DATE:	03/03/2025
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Office Manager Maria Cervantes		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff neglect resulted in Resident #1 (R1) sustaining a severe burn.
Staff did not seek medical attention for the resident in a timely manner.

INVESTIGATION FINDINGS:

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On 03/03/2025 at 03:30 PM, Licensing Program Analyst (LPA) Melody Brown, visited the facility to deliver the investigative findings for the above allegations. LPA Brown identified herself and discussed the purpose of the visit with Office Manager Maria Cervantes. The investigation consisted of file review, interviews with residents and staffs as well as observation.

First allegation: Staff neglect resulted in Resident #1 (R1) sustaining a severe burn. The investigation was conducted by Department staff which consisted of file review and interviews with relevant parties. The first allegation indicates that staff neglect resulted in Resident #1 (R1) sustaining a severe burn. During the investigation, Department staff reported that there was insufficient evidence to support staff neglected Resident #1 (R1). Department staff interviewed R1 and R1 denied any neglect from the staffs at the facility. R1 revealed that R1 likes to do things without assistance which includes transferring to/from bed and make R1's own coffee. Moreover, R1 indicated the burn injury resulted from R1 accidentally hitting R1's wheelchair's cupholder that held the hot coffee. ***Continuation in LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20240701105144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: BRASWELL'S CHATEAU VILLA	FACILITY NUMBER: 360902129
	VISIT DATE: 03/03/2025

NARRATIVE

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R1 did not report R1's burn wound to facility staff until days later.

Second allegation: Staff did not seek medical attention for the resident in a timely manner. The investigation was conducted by Department staff which consisted of file review and interviews with relevant parties. During the investigation, Department staff was not able to obtain evidence to corroborate the allegation. Department staff indicated that R1 denied neglect and R1 stated that R1 did not request earlier medical attention as R1 informed department staff that R1 did not say anything about the incident to the staffs at the facility. Department staff interviews with staffs revealed that R1 likes to complete several of R1's Activities of Daily Living (ADLs) without staff assistance. To add to that, interviews with staffs indicated that R1 has a coffee pot in R1's room and R1 prefers to make coffee without staff assistance and when R1 decided to disclose R1's burn wound, they were more concerned with getting R1 immediate medical care than asking R1 why R1 did not report R1's burn injury sooner.

Therefore, based on the evidence obtained during the Department's investigation, there is insufficient evidence to prove that staff neglect resulted in Resident #1 (R1) sustaining a severe burn (Allegation #1), and staff did not seek medical attention for the resident in a timely manner (Allegation #2) are UNSUBSTANTIATED at this time. Although the allegation of staff neglect resulted in Resident #1 (R1) sustaining a severe burn (Allegation #1), and staff did not seek medical attention for the resident in a timely manner (Allegation #2) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report (LIC9099), was discussed and provided to Office Manager Maria Cervantes.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025

LIC9099 (FAS) - (06/04)

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